Overview
Work History
Education
Skills
Timeline
Generic

Carmen Maestre

Kewanee,Illinois

Overview

6
6
years of professional experience

Work History

Customer Service Representative

Cigna
09.2023 - 01.2025
  • Managed 250-300 inbound and outbound calls, assisting customers with inquiries about healthcare plans, and benefits
  • Provided bilingual support in English and Spanish, ensuring clear communication and positive customer experiences
  • Conducted designed outbound multi-touch member retention and engagement campaigns for a designated book of business
  • Advocated for members by taking ownership, acting with empathy, and helping our members resolve their situation the first time
  • Provided our members with a personalized and rewarding experience by helping our members to feel valued, empowered, and understood
  • Leveraged resources and technology to optimize the member experience
  • Problem-solved and navigated multiple computer applications while interacting with the member over the phone or while on video conference
  • Ensuring that the detailed call information is captured in Customer Relationship Management system (CRM) and appropriately dispositioned the call
  • Met/Exceeded call center metrics and expectations consistently (quality, adherence, campaign outcomes, attendance, etc.)
  • Conducted telephonic outreach and health coaching to members. Educate members about care gaps during medical appointments. Scheduled doctor appointments for members with care gaps
  • Performed telephonic HRA (health risk assessment) to determine patient's needs

Project Counselor/Customer Service

Maximus (Iconma, LLC)
08.2021 - 08.2023
  • Responsible for reaching out to program participants and supporting connections to existing job placement and employment services resources
  • Placed outbound calls (approximately 250-300 calls per day) and provided job training, childcare resources, as well as healthcare information about local programs available within the community
  • Address special issues affecting participants
  • Consider barriers to employment in making program placement decisions
  • Refer applicants and participants to community resources and provide follow-up

Benefits Verification Specialist

AmerisourceBergen (Mind lance Staffing)
10.2020 - 07.2021
  • Managed approximately 200 calls, emails and faxes per day
  • Verified patient medical and pharmacy insurance benefit and eligibility pertaining to specialty medications as well as documentation, including patient coverage, cost-sharing, and access/provider options
  • Worked independently, managed daily work queues in an organized manner, and resolved issues in a timely manner
  • Documented and initiated prior authorizations and claims appeals
  • Completed quality review of work as part of finalizing the product
  • Reported any reimbursement trends or delays to management

Senior Health Information Specialist/Medical Records

Conifer Health Solution
07.2019 - 10.2020
  • Streamlined the release of information process for patients, ensuring timely access to their medical records while maintaining strict confidentiality.
  • Processed documents for scanning and indexing by determining which documents needed to be scanned as part of the patient's medical record, preparing the documents
  • Scanning Functions - Processed documents for indexing by performing daily maintenance on the scanner to ensure optimal image results, performing a check of the documents to ensure they are ready for scanning (ensuring all staples and paper clips have been removed; applying correct labels), creating an appropriate batch for scanning, and scanning each batch ensuring that documents are scanned correctly and moved to the correct status
  • Reviewed the quality of scanned patient medical records and indexed all patient charts to ensure the highest level of quality

Health Information Specialist/ Medical Records

Ciox Health
09.2018 - 07.2019
  • Managed Requests: Received and processed requests for the release of information, including medical records, legal documents, or other sensitive data
  • Participated in training programs to enhance knowledge and skills in areas such as HIPAA regulations or legal requirements
  • Reviewed Documents: Carefully reviewed and assessed documents to identify any confidential or sensitive information that may require redaction or special handling
  • Maintained a thorough understanding of privacy laws and regulations to ensure compliance during the release process
  • Located and retrieved relevant records from electronic databases, paper files, or other storage systems
  • Record Retention: Maintained organized and secure records of released information, including documenting retention schedules and adhering to record retention policies
  • Record Retention: Maintained organized and secure records of released information, including documenting retention schedules and adhering to record retention policies
  • Supported clinical staff by following up on appointments, missing case information, and medical records via phone, fax, mail, and email

Education

A.S. Degree - Medical Office Administration

Herzing University
Menomonee Falls, WI
08.2019

Skills

  • Bilingual Spanish and English
  • Medical Terminology
  • Electronic Medical Records (EMR)
  • SharePoint CMR
  • Customer service
  • Data entry
  • Problem resolution

Timeline

Customer Service Representative

Cigna
09.2023 - 01.2025

Project Counselor/Customer Service

Maximus (Iconma, LLC)
08.2021 - 08.2023

Benefits Verification Specialist

AmerisourceBergen (Mind lance Staffing)
10.2020 - 07.2021

Senior Health Information Specialist/Medical Records

Conifer Health Solution
07.2019 - 10.2020

Health Information Specialist/ Medical Records

Ciox Health
09.2018 - 07.2019

A.S. Degree - Medical Office Administration

Herzing University

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Carmen Maestre